Borderline Personality Disorder May Delay Depression Remission

Depression can be challenging to treat. Whether it is approached with interpersonal psychotherapy (IPT), cognitive behavioral therapy (CBT), mindfulness-based therapy, medication, or a combination of treatments, some individuals with depression endure significant symptoms. The presence of another psychological problem, such as anxiety, posttraumatic stress, or phobia, can make it even more difficult to achieve remission. In a recent study, Jessica C. Levenson of the University of Pittsburgh’s Department of Psychology examined whether personality disorders affected treatment outcomes for depression. She also wanted to determine if the type of treatment administered strengthened or weakened any affect.

Levenson enlisted 275 individuals with major depression and enrolled them in a treatment protocol that consisted of IPT or medication. She evaluated the participants for symptom severity and comorbidity of borderline personality disorder and then gauged remission rates from treatment conclusion to three months post-treatment. She found that the participants who had only one personality disorder did not have lower remission rates than those with no comorbid conditions. However, individuals with multiple dimensions of personality took longer to achieve remission, regardless of whether they received IPT or medication. “The findings support our hypothesis that a higher level of personality pathology is related to longer time to remission from depression, with borderline personality pathology carrying the majority of this effect,” Levenson said.

The results of this study shed some light on factors that may contribute to treatment resistance in people with depression. Even if they have never been diagnosed with borderline personality disorder, the existence of symptoms related to that could impair treatment success. Levenson cautions that changes to the upcoming DSM-V could make identification of those at risk for personality disorders even more difficult. With respect to these findings, she notes that they should be considered in light of their limitations, which include a short follow-up period and primarily white participant sample. Despite those shortcomings, Levenson believes that these results have important implications and could help clinicians be prepared for treatment resistance and extended durations of time for clients with depression and borderline personality disorder to achieve remission.

Reference:

Levenson, Jessica C., Meredith L. Wallace, Jay C. Fournier, Paola Rucci, and Ellen Frank. The role of personality pathology in depression treatment outcome with psychotherapy and pharmacotherapy. Journal of Consulting and Clinical Psychology 80.5 (2012): 719-29. Print.

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